Cellular Mechanisms of Aneurysm Occlusion after Treatment with a Flow Diverter

Kadirvel, Ramanathan; Ding, Yong Hong; Dai, Daying; Rezek, Issa; Lewis, Daniel C.; Kallmes, David F.

doi:10.1148/radiol.13130796

Cited by 183 publications

(140 citation statements)

References 20 publications

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“…The neo-endothelialization and subsequent occlusion of the aneurysm depend on an underlying SMCs substrate 23. It is possible that a higher amount of NIH, especially at the level of the neck, would lead to higher occlusion rates.…”

Section: Discussionmentioning

confidence: 99%

The occurrence of neointimal hyperplasia after flow-diverter implantation is associated with cardiovascular risks factors and the stent design

Caroff

Iacobucci

Rouchaud

et al. 2018

J NeuroIntervent Surg

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BackgroundNeo-intimal hyperplasia (NIH) is frequently observed after flow-diverter stent (FDS) implantation. Although mostly asymptomatic, this vascular response can sometimes lead to delayed ischemic strokes. This study intended to evaluate the factors potentially influencing the rates of NIH following FDS treatment.Material and MethodsAll aneurysm treatments performed with a Pipeline embolization device (PED) or a SILK stent from May 2011 to May 2015 were collected in a prospectively maintained database. Patient demographics, clinical, and angiographic outcomes including both digital subtraction angiography and C-arm cone-beam CT were registered. Two blind reviewers rated the presence of NIH on a binary scale (present/absent).ResultsFrom 148 patients, 63 datasets were available for analysis. Inter-reader agreement was excellent (Kappa=0.88). NIH was positively correlated with smoking, dyslipidemia, and high blood pressure, but not with aneurysm characteristics. At early follow-up (<12 months), NIH was more frequently associated with the use of the SILK stent (68%) rather than the PED (38%): P<0.02. At long-term follow-up, the NIH rate in the total population dropped from 55% to 26% with no more significant difference between the two stents. The complete occlusion rate as seen in early follow-up was higher in the SILK group with 76% vs 65% but without statistical significance (P=0.4).ConclusionNIH is a dual-vessel reaction after FDS implant. When planning a treatment in locations at risk of ischemic complications if severe NIH would occur, then the stent design should be considered. However, minimal NIH might also be needed as it is involved in aneurysm healing. Before treatment patients should be recommended best medical management of their cardiovascular risks factors to prevent an excessive NIH reaction.

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Section: Discussionmentioning

confidence: 99%

The occurrence of neointimal hyperplasia after flow-diverter implantation is associated with cardiovascular risks factors and the stent design

Caroff

Iacobucci

Rouchaud

et al. 2018

J NeuroIntervent Surg

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“…23,24 Therefore, the previous classifications, particularly Raymond-Roy Occlusion Classification, described for coiled aneurysms could not address the results of flow modification treatments. Several new classifications 14,17 have been introduced.…”

Section: Discussionmentioning

confidence: 99%

A New Aneurysm Occlusion Classification after the Impact of Flow Modification

Cekirge

Saatçi

2015

AJNR Am J Neuroradiol

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SUMMARY:A new classification is proposed for cerebral aneurysms treated with any endovascular technique, for example, coiling with or without adjunctive devices, flow diversion, intrasaccular flow modifiers, or any combination of the above. Raymond-Roy Occlusion Classification is expanded with novel subgroups such as class 1 represents complete occlusion and is subdivided if a branch is integrated to, or originated from, the aneurysm sac; class 2 represents neck filling; class 3 represents incomplete occlusion with aneurysm filling as in the previous classification; and class 4 describes the immediate postoperative status after extra-or intrasaccular flow modification treatment. A new concept, "stable remodeling," is included as class 5, which represents filling in the neck region that stays unchanged or reduced, as shown with at least 2 consecutive control angiographies, at least 6 months apart, for not Ͻ1 year, or the remodeled appearance of a dilated and/or tortuous vessel in continuation with the parent artery without sac filling. ABBREVIATION: FM ϭ flow modifier

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“…These new devices comprise a high-attenuation braided mesh stent placed in the parent artery at the level of neck which disrupts the intra-aneurysmal flow and subsequently creates intra-aneurysmal thrombosis; the exposed surface of the FDD is also a good support for the development of the neointima 1 2…”

Section: Introductionmentioning

confidence: 99%

p64 Flow Modulation Device in the treatment of intracranial aneurysms: initial experience and technical aspects

Briganti

Leone

Marseglia

et al. 2015

J NeuroIntervent Surg

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Treatment of cerebral aneurysms with the p64 Flow Modulation Device is a safe procedure with no technical complications. The mechanical detachment and the 100% retrievability are significant advantages of this new device. However, large prospective studies with long-term clinical and angiographic follow-up are necessary to assess the role of the p64 in the endovascular treatment of intracranial aneurysms.

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Cellular Mechanisms of Aneurysm Occlusion after Treatment with a Flow Diverter

Cited by 183 publications

References 20 publications

The occurrence of neointimal hyperplasia after flow-diverter implantation is associated with cardiovascular risks factors and the stent design

The occurrence of neointimal hyperplasia after flow-diverter implantation is associated with cardiovascular risks factors and the stent design

A New Aneurysm Occlusion Classification after the Impact of Flow Modification

p64 Flow Modulation Device in the treatment of intracranial aneurysms: initial experience and technical aspects

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